Healthcare Provider Details

I. General information

NPI: 1336011709
Provider Name (Legal Business Name): CANOE HEALTH ALLIANCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2025
Last Update Date: 09/23/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

62430 US HIGHWAY 285
BAILEY CO
80421
US

IV. Provider business mailing address

7231 TIMBER TRAIL RD
EVERGREEN CO
80439-6696
US

V. Phone/Fax

Practice location:
  • Phone: 217-417-5963
  • Fax:
Mailing address:
  • Phone: 217-417-5963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE A LEOPOLD
Title or Position: FOUNDER
Credential: APN
Phone: 217-417-5963